Application Status Query

Instructions: 

Please allow one hour after receipt of your status update email for the updates to be reflected in the online checklist.

Please verify the checklist information below, including your address. If your address has changed, please e-mail your application number, name, profession, along with your old and new address. The Credentialing department posts status information following receipt and review of application materials.

As of  :  05/12/2017
Application#  :  603510
Name  :  AZENABOR, OKWUCHI N
Profession  :  Dentistry
Address  :  GLENDALE, WI
Application Status  :  (Permanent license issued)


Requirements Not Met:
Description Status Comments (Please note, not all requirements will include comments)

Requirements Met:
Description Status Comments (Please note, not all requirements will include comments)
Application Complete Met
Application Fee Met
$150
Wisconsin Statutes & Rules Examination Met
4/4/2017: Before you start the exam review the instructions at: http://dsps.wi.gov/Default.aspx?Page=972423f1-c1fc-4b94-92c2-3a438a6e0326. Open book exam is on our website at http://eptol.drl.wi.gov/. Passing score is 85%. Each attempt of this exam costs $75. If you receive a failing score and are required to retake this exam, you will be required to pay another $75 fee for every attempt of this exam
Choose from the drop down menu: Test Launching.
When you're at the ParTest Online you will need the following info:
Instructor: gsp
Test Name: DEN10A (case sensitive)
Test Password: DEN10A (case sensitive)
Student ID is your Application ID
Link to related Statutes and Rules governing Dentistry (copy and paste the URL into your browser): http://dsps.wi.gov/Boards-Councils/Administrative-Rules-and-Statutes/Dentistry-and-Dental-Hygiene-Administrative-Rules-and-Statutes/
Name is not same on all credentials received, provide previous names. Met
All activities and practice accounted for from the date of graduation to the present. Provide employers name, location (city&state), dates (month&year), # of hours worked per week, job title & duties Met
National Practitioner Data Bank Report/Self-query response Met
4/4/2017: Go to: http://www.npdb-hipdb.hrsa.gov/. Go to “For Health Care Professionals”, click on the option that reads: “How to Get Started” and then click on “Start or Check a Self-Query”. Follow the directions on the website to complete the process. If you receive this report electronically directly from the reporting agency, you must forward the original email you received from them with the link to access the report along with the attachment of the original PDF report you downloaded with their link. Please forward the email and the attached report directly to me (DSPSCredDentistry@WI.gov). Or, send me the original report with the envelope by mail. Please allow 7-10 business days for processing once received here in the Department.
Certificate of Professional Education (Form #1504) Met
4/4/2017: NEED: Form # 1471 sent to us directly from your dental school. If you have not already done so, please download Form #1471 from the DSPS website (http://dsps.wi.gov), complete your portion, and submit to your school for completion and direct submission to: DSPS, ATTN: DENTISTRY EXAMINING BOARD, P.O. BOX 8935, MADISON, WI 53708-8935. Forms sent by applicant will be denied. Please have your school mail the form to us directly. Thank you. Please allow 7-10 business days for processing once received here in the Department.
Regional Dental Testing Service Score Card(s) (Original(s) pass & fail) Met
NEED: Original score reports (both pass and fail) upon completion of exams. Photocopies OR faxes are not acceptable. Upon registering for exams or upon completion of exams, please request your scores from the testing service to be sent to Wisconsin DSPS. For your National Dental Examination score report, please contact the ADA. You will need a DENTPIN in order to authenticate your request. Search for your DENTPIN here: http://dts.ada.org/CustomerServices_ADA/RetrieveDENTPIN.aspx?transaction=DAT. Or call the agency at – (312) 440-2500. Regional exam contact information will vary depending on which exam you took. If you need assistance finding contact information for a regional testing service, please call us at: 608-266-2112. The testing service should mail your scores directly to: DSPS, ATTN: DENTISTRY EXAMINING BOARD, P.O. BOX 8935, MADISON, WI 53708-8935. Please allow 7-10 business days for processing once received here in the Department.
National Board Score Card(s) (Original(s) pass & fail) Met
NEED: Original score reports (both pass and fail) upon completion of exams. Photocopies OR faxes are not acceptable. Upon registering for exams or upon completion of exams, please request your scores from the testing service to be sent to Wisconsin DSPS. For your National Dental Examination score report, please contact the ADA. You will need a DENTPIN in order to authenticate your request. Search for your DENTPIN here: http://dts.ada.org/CustomerServices_ADA/RetrieveDENTPIN.aspx?transaction=DAT. Or call the agency at – (312) 440-2500. Regional exam contact information will vary depending on which exam you took. If you need assistance finding contact information for a regional testing service, please call us at: 608-266-2112. The testing service should mail your scores directly to: DSPS, ATTN: DENTISTRY EXAMINING BOARD, P.O. BOX 8935, MADISON, WI 53708-8935. Please allow 7-10 business days for processing once received here in the Department.
AED/CPR Certification Met
4/4/2017: NEED: Submit photocopy of both front and back of a current certification card(s) from a board approved provider. Please see website for approved certification providers (http://dhs.wisconsin.gov/ems/license_certification/cpr.htm). Send via US Mail, by secure fax to: 608-261-7083 or by email to DSPSCredDentistry@WI.gov. Please allow 7-10 business days for processing once received here in the Department.